Provider Demographics
NPI:1821357047
Name:HUGO, MICHAEL V (ACSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:HUGO
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2613
Mailing Address - Country:US
Mailing Address - Phone:847-322-7585
Mailing Address - Fax:
Practice Address - Street 1:505 E HAWLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2494
Practice Address - Country:US
Practice Address - Phone:847-347-7367
Practice Address - Fax:224-513-4700
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490034141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical